The impact of the COVID-19 pandemic on the mental health of healthcare workers:study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study

BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00127-021-02211-9

Implementation of an indoor smoking ban and an advertising/ sponsorship ban in Lebanon: a baseline cross-sectional study

Introduction Although the majority of countries ratified the World Health Organization Framework Convention on Tobacco Control, few have comprehensive smoke-free laws and compliance is not always satisfactory. In 2011, Lebanon, having among the highest smoking rates in the Eastern Mediterranean Region, passed a comprehensive tobacco control law (Law 174). This study aimed to assess compliance with Law 174 among smokers and non-smokers in Beirut (the capital), three months after the ban in closed public places and on advertisement and promotion came into effect. Methods A population-based cross-sectional survey was conducted. Multi-stage cluster sampling identified 159 households, yielding 468 respondents aged 15-65 years. Data was collected face-to-face using a structured questionnaire. Weighted descriptive and bivariate analyses were performed. Results Three months after the ban came into effect in 2011, all respondents knew about Law 174. Around half witnessed other people smoking in their workplace (44.2%), restaurants/coffee shops (52.8%) and public transportation (60.0%) in the past months. Less than 20% witnessed any tobacco promotion/advertisements, reflecting good compliance of the advertising sector. Overall, more than half the smokers continued smoking (workplace/closed public places). Conclusions This study provided information about compliance to the smoking ban in Beirut. The advertising sector's compliance would hopefully decrease the tobacco industry’s influence on the public. Further studies aiming at understanding the underlying factors behind the lack of compliance to the indoor smoking ban and finding effective solutions in a politically unstable country with weak rule of law like Lebanon are crucial and can serve as an example for similar developing countries

The Culturally and Contextually Sensitive Assessment of Mental Health using a Structured Diagnostic Interview (MINI Kid) for Syrian Refugee Children and Adolescents in Lebanon: Challenges and Solutions

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective paper aimed to review challenges and share lessons learned from the process of administration and supervision of a structured clinical interview, the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and the Clinical Global Impression (CGI) severity scale, with N=119 Syrian refugee children (aged 8-17) resident in informal tented settlements in Lebanon. Qualitative data was derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: 1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); 2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); 3) cultural norms and meaning (impact of different meanings on answers); 4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and 5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improve accessibility, and consideration for inter-connected formulations is essential to help inform prevalence rates, treatment plans, and public health strategies